State of the Clinical ABA “Industry”

It has been said we are in a golden age of behavior analysis. Nowhere is this more evident than in the clinical application of behavior analysis to the treatment of autism spectrum disorders. Behavior analysis has produced knowledge and understanding of behavior that has led to innovative approaches and spectacular results in treating individuals with special needs. As families, the academic community, and the general public have become more aware of these successes, our behavioral science has only continued to grow in demand and popularity. And, as in any good free-market society, so too have the number of businesses in this field grown.

In 1985 business guru, and father of modern management, Peter Drucker wrote his classic book Innovation and Entrepreneurship which may give us insights into the future for this application of behavior analysis (note, the rest of this article discusses specifically behavior analysis in autism treatment, not the field as a whole).

In this book, he describes “industries” that arise around the applied use of new knowledge (think new knowledge in engineering, computer sciences, biological processes, and now behavioral processes). This description is very similar to what we have and are seeing in the application of behavior analysis in the treatment of people with autism spectrum disorders.

According to Drucker, this”knowledge-based innovation” begins with a long period in which the knowledge is there, the “pieces of the puzzle” are there, and many people can see change or growth coming. Yet often nothing happens for years. And then, almost suddenly, there is a convergence, a coming together of the pieces, in which a catalyst of some sort creates explosive growth with this knowledge-based innovation.

We can see parallels in the field of clinical ABA. Behavior analysts have been developing new knowledge of treating people with special needs for more than half a century, and we have been saying we can change the world with behavior analysis for even longer. Yet, there was no “boom” in the application of this science. Then over the last 25 years, several events appear to have served as catalysts to bring the pieces together to launch behavioral approaches to autism treatment to new prominence. Effective user testimonials, Lovaas’ 1987 study, the professionalization of the field with the BACB, the increase in diagnosis rates of ASD, and other such events have all converged and catalyzed the growth of this application of behavior analysis.

This initial phase in knowledge-based innovation is followed shortly by what Drucker calls “The Window” which is a turbulent time of rapid change. New competitors constantly enter the market as the growth continues, and fresh talent begins flocking to the field. I believe this is currently the phase in which clinical ABA now finds itself. If you have ever described practice in clinical ABA as “the wild west”, then you have made the very same observation.

Then, according to Drucker, comes “The Shakeout”, a period of massive consolidation in which the vast majority of companies either fail, or are consumed by larger companies. Companies who are able to rapidly adapt to change, and continually innovate tend to be the ones who thrive in The Shakeout. After The Shakeout, only a hand full companies still exist, typically dominated by a few mega companies. Research since Drucker’s time has validated this idea and shown a relatively consistent pattern with new fields and industries throughout modern industrialized history. This process is sometimes called “the consolidation curve”. There are numerous examples of the pattern occurring time and again across many industries:

Automobiles: In the early 1900s the US, supported more than 200 different car manufacturers, by the 1960s that number had shrunk to just 4. Today there are 2 survivors (Ford and GM), and about 9 or 10 that dominate the field globally.

Airlines – Since the beginning of commercial aviation in the 1920s, there have been more than 500 airline companies in the US. Today there are just 4 major carriers – American, United, Delta, Southwest – that command the majority of the market, with a few more minor players (Virgin, Alaskan, JetBlue, etc.).

Personal computers: In the late 1970s the personal computer hit the scene, with scores of companies like Commodore, Apple, and Dell entering the market, each with their own product models. Today, just 6 companies sell close to 75% of all computers (Lenovo, HP, Dell, Asus, Apple, Acer).

Drucker suggests this mass extinction he calls “The Shakeout” can take as little as 5 years, but in most cases, this cycle appears to take decades. Additionally, the cycle seems to reset, or at least encounter major turbulence whenever there is new technological development. Yet, Drucker also makes another very interesting observation of what typically occurs during The Shakeout, “without exception the survivor has been a company that was started during the early explosive period.” (p. 121). Does this mean that of the clinical ABA companies that exist today, there already exist those who will dominate the field in the years to come? Very hard to say with any confidence.

If history and the research of business thinkers like Peter Drucker is any lesson, we can expect this “wild west” period in clinical ABA autism treatment to be followed in the near future by a consolidation of companies. While it’s hard to find good data to indicate where we may be in this process, I would guess we have several more years in “The Window”, as new companies are continuing to open at a rapid pace. Yet there are early signs “The Shakeout” may be on its way. For example, how many of you owners of ABA companies have been approached by larger ABA companies, or even private equity firms to discuss a buy out?

So what differentiates companies that survive “The Shakeout” from those who don’t? In addition to a healthy dose of luck, Drucker suggests one business practice is absolutely key:

Entrepreneurial Management

In short, entrepreneurial management describes behavioral, procedural, and structural practices of organizational leaders in established companies that allow for adaptability, innovation and entrepreneurship. Essential behaviors for survival of “The Shakeout”.

Yet, according to Drucker, entrepreneurial management practices can be extremely difficult for the technical innovators and experts (i.e. the behavior analyst in our case) to adopt. He suggests such people “tend to be contemptuous of anything that is not “advanced knowledge,” and particularly of anyone who is not a specialist in their own area. They tend to be infatuated with their own technology, often believing that “quality” means what is technically sophisticated rather than what gives value to the user” (p. 119). I am sure you know no behavior analyst who fits that bill, but perhaps you have heard stories of some who might.

So what Entrepreneurial Management practices help organizations survive The Shakeout?

Drucker lists several key practices of entrepreneurial management which help companies remain adaptive and innovative. All of these practices align well with behavioral principles, and specifically Organizational Behavior Management (OBM) – the application of behavior analysis to organizational performance.

Entrepreneurial Policies – Drucker states “Innovation must be part and parcel of the ordinary, the norm, if not routine” (p. 151). Establishing formal policies to encourage variability and innovation in employee behavior is key. Policies like time to work on new projects, and budgeting resources for innovation helps support this.

Entrepreneurial Practices – This speaks to the behavioral patterns among leaders – do they reinforce innovative behavior and adaptability in others, or punish it? Do they establish standing meetings in which new opportunities facing the company are discussed?

Measuring Innovative Performance – Any behavior analyst can easily see the value in this point, as measurement means data, and data is key to making real change. As Drucker says “for a business to be receptive to entrepreneurship, innovative performance must be included among the measures by which that business controls itself” (p. 158).

Structures – For innovation to thrive within a company, the new must be protected from the old. The company must be specifically structured in a way to allow innovative behavior to flourish, rather than be destroyed by the grind of existing business. As Drucker puts it “The people responsible for an existing business will therefore always be tempted to postpone action on anything new, entrepreneurial, or innovative until it is too late” (p. 162).

Staffing – Drucker’s point here is very behavioral – he suggests that there is no “entrepreneurial personality” or people who are born entrepreneurs. Rather, we should look for those who have demonstrated willingness to learn and adapt, and put them in a system that supports such behavior.

So what do we make of all of this? The takeaway here is that no matter the field or industry, the pattern of knowledge-based innovation has remained remarkably consistent. It stands to reason then that we can expect the same “Shakeout” to occur at some point in the future with clinical ABA service organizations. But, Peter Drucker outlined several practices that successful innovators use to adapt and grow, which can serve leaders in clinical ABA service companies very well. Specifically, leaders should seek to adopt: entrepreneurial policies and practices, measure innovation, structure the organization to foster innovation, and seek to employ and support those who display the right behaviors for innovation. These practices, paired with behavioral principles will help organizations to thrive.